Aetna Automates the "Black Box" Era of Physician Underpayment, Skitish Voters Join a Kumbaya-Style Agreement for Drug Regulation, and Novo and Hims Pretend to Be Friends

Hey all,

Happy Thursday! Between Aetna’s automated downcoding algorithms and Novo’s PR-driven concern for the "safety" of compounded weight-loss drugs, it’s heartening to see the medical-industrial complex finally treat patient care with the same cold, calculated efficiency as a high-frequency trading desk. While insurers use black-box software to decide that an ER doctor’s life-saving intervention is worth less than a plumbing repair, pharmaceutical giants are busy weaponizing regulatory red tape to protect their stock prices from the looming threat of affordable generic competition. It seems the only thing more certain than Americans skipping doses to pay rent is the industry’s uncanny ability to wrap its naked pursuit of profit in the soothing, if entirely transparent, language of "integrity" and "public health."

Enjoy the rundown!

Jacob Brody (Co-Founer & CEO, ZorroRX)

[HEALTH CARE un-covered] Aetna’s New Automatic Algorithm for Paying Doctors Less

Aetna is utilizing automated "black box" software to downcode emergency room claims without reviewing medical records, effectively reducing payments to doctors for high-severity visits. This practice forces medical providers to navigate a complex, insurer-controlled appeals process to recover lost revenue for life-saving care that the algorithm unilaterally deems over-billed. It is truly a masterclass in corporate irony to watch an insurer cough up $117 million to settle its own fraud allegations while simultaneously using an algorithm to lecture ER doctors on the ethics of being paid slightly more than the guy who comes over to fix a leaky faucet.

Full Article

[KFF] Public Views on Prescription Drug Costs

A record 59% of U.S. adults now report worrying about their ability to afford prescription medications, with 43% admitting they have skipped doses or used over-the-counter alternatives due to high costs in the past year. While most Americans remain skeptical that any current administration policies will actually lower their pharmacy bills, about one in four voters has reached a state of "political zen" by trusting absolutely neither party to fix the problem. It turns out that prescription drug prices have achieved the impossible: uniting over 70% of Republicans, Democrats, and Independents in a rare, kumbaya-style agreement that the government definitely needs to step in and regulate the industry more.

Full Article

[Drugstore Cowboy] Novo v Hims: We’ve Only Just Begun

Novo Nordisk and Hims have struck a suspicious ceasefire by agreeing to distribute branded GLP-1s, yet the deal’s lack of clear enforcement suggests the real battle over compounding has merely shifted from the courtroom to the laboratory. Novo has already fired the next shot by releasing a safety report that implies compounded semaglutide might be more of a "mystery box" than a medical treatment, signaling that the legal war is now a public relations knife fight. It’s a heartwarming tale of two corporate behemoths using "patient safety" as a convenient mask for a desperate attempt to stabilize their tanking stock prices while fighting over who gets the biggest slice of America's multi-billion-dollar weight-loss pie. Full Article